A Lamaze pioneer tells why she believes in and promotes preparedness and family-centered maternity care.

It must have been close to 30 years ago when my mother asked if she could observe one of my childbirth preparation classes. I was delighted to have her come. It was an opportunity for me to show her my work and to be able to discuss it with her at length afterwards.

We were living on different continents at the time, and she had come to the United States for a visit. It turned out to be the last visit before her death in London.

She herself was the mother of five children. As far as I know, we were all born at home in a suburb of Berlin, in a big rambling house by the river. That house was and still is for me the whole essence of my childhood.

Because we had been separated for many years, due to the political circumstances in Germany and World War II, we had never talked about her own childbirth experiences.

I often wondered what it must have been like to give birth at home in the house that I knew so well, in the bedroom with its white and blue drapes, with its white bedspreads and dark blue wallpaper. I knew that she had had the help of a midwife who lived in the same small suburb, as well as the help of the local general practitioner who was a lifelong friend and frequent guest in my parents' house.

While my mother was watching my class, she suddenly spoke up near the end of the session and said, "I wish someone had told me all about labor and delivery, and I wish they had taught me to use my body correctly. I did not know how to help myself. And I wish someone had shown me how to relax. Nobody told me anything beforehand," she added. "I was frightened and helpless and very lonely."

To my knowledge, my father was not an active participant during his children's births, though he certainly made up for it later by being the most nurturing and caring father one can imagine.

Since my mother gave birth two generations ago (almost three, in fact!), obstetrics has changed greatly. There was a whole generation of women who gave birth between the 1930s and 1960s who opted to be entirely out of the picture. They were the generation who liked and demanded twilight sleep to make them forget their pain and fears. This seemed to make it easier for them to endure the thought of being taken out of their homes into unfriendly and cell-like hospital rooms, where they were isolated as if suffering from a communicable disease. There they had their babies, hands and legs strapped down so they would not fall off the delivery table or perhaps touch any of the sterile drapes. A woman had become an unconscious object from whose pelvis a baby was extracted with no concern for her feelings or emotions.

But Things Changed

Just as there are different developments and phases in life, so women changed the philosophy and practice of obstetrics. They started to demand an active role in the birth of their babies.

In the 1960s, this was a revolutionary idea – as revolutionary as it had been when more than 100 years earlier, Queen Victoria accepted chloroform for the birth of her sixth child, Prince Leopold. The queen was the first woman to give birth to a child under an anesthetic, and her decision was against all religious doctrines and social customs of her time.

Part of the more recent revolution occurred in 1960 when the American Society for Psychoprophylaxis in Obstetrics was founded. The organization, first known as ASPO/Lamaze and now as Lamaze International, was to become one of the most important childbirth organizations in the country.

A Consumer Movement

Since the beginning, the prepared childbirth movement has been a consumer movement. Its ideas and philosophy were accepted by large numbers of women and men who asked their obstetricians to support a birth in which they could be active participants. They convinced some of the doctors and a good number of nurses that it would be a great advantage for women to learn about the process of labor and delivery preceding the child's birth.

These men and women pointed out that if the mother was given tools to help herself during the stressful experience of labor, then healthier mothers and babies would be the result. The use of medication could be reduced, and having a baby could be made into a rewarding and humane experience instead of a traumatic one.

The fight, for recognition of the idea of family-centered maternity care, in which fathers and children become part of the birth experience, was a slow and hard fight. Acceptance did not come overnight. I remember well how I was told that, surely, this was all a fad, that women would soon forget and that ideas as strange as encouraging a woman to be awake and aware while giving birth were beyond all rational thinking.

I was certainly considered a radical during this period, someone whose ideas had no earthly chance of surviving more than a year or so. (Being considered a radical some years ago may sound strange to some of my younger colleagues today, some of whom now think of me as rather old-fashioned. Even though this may not be entirely true, it's a good healthy sign that our work is alive and moving forward in many new directions.)

A Household Word

Obstetrics has become an intricate science in the last 15 years. Important discoveries have been made to improve the chances for women to have healthy babies and to prevent a great number of formerly incurable diseases. At the same time, however, prepared childbirth, childbirth education and, above all, the name Lamaze have become household words here and in Western Europe.

The advances in science have not pushed the advances in humanizing birth into the background. On the contrary, childbirth education has become such a normal part of prenatal care that there is rarely a hospital that does not offer classes to pregnant women and their partners. This so-called fad has been proven not to be a fad, but is now an accepted and valued way of providing prenatal care.